<h:html xmlns:h="http://www.w3.org/1999/xhtml" xmlns="http://www.w3.org/2002/xforms" xmlns:ev="http://www.w3.org/2001/xml-events" xmlns:xsd="http://www.w3.org/2001/XMLSchema" xmlns:jr="http://openrosa.org/javarosa">
	<h:head>
		<h:title>E-CTC Form V8 - Patient Triage Protocol</h:title>
		<model id="CDCDemo">
			<itext>
				<translation lang="English" default="">
					<text id="question1">
						<value form="long">Eng: Enter ARV Regimen</value>
						<value form="short">ARV Regimen</value>
					</text>
					<text id="question1hint">
						<value form="">Select your Regimen</value>
					</text>
					<text id="queOneLabel1">
						<value form="">1a30:d4T30-3TC-NVP</value>
					</text>
					<text id="queOneLabel2">
						<value form="">1a40:d4T30-3TC-NVP</value>
					</text>
					<text id="queOneLabel3">
						<value form="">1a30-S: starting</value>
					</text>
					<text id="queOneLabel4">
						<value form="">1a40-S: starting</value>
					</text>
					<text id="queOneLabel5">
						<value form="">1b:ZDV-CTC-NVP</value>
					</text>
					<text id="queOneLabel6">
						<value form="">1c:ZDV-3TC-EFV</value>
					</text>
					<text id="queOneLabel7">
						<value form="">1d40:d4T40-3TC-EFV</value>
					</text>
					<text id="queOneLabel8">
						<value form="">2b:ABC-ddl-SQV/r</value>
					</text>
					<text id="queOneLabel9">
						<value form="">2a:ABC-ddl-LPV/r</value>
					</text>
					<text id="queOneLabel10">
						<value form="">2c:ABC-ddl-NFV</value>
					</text>
					<text id="queOneLabel11">
						<value form="">Other regimen</value>
					</text>
					<text id="queOneLabel12">
						<value form="">Not on Arvs Yet</value>
					</text>
					<text id="question2">
						<value form="long">ASK: The Records indicate that your current regimen is 1c:ZDV-3TC-EFV. Has this changed?</value>
						<value form="short">Regimen Changed</value>
					</text>
					<text id="question2hint">
						<value form="">Select your Current Regimen</value>
					</text>
					<text id="queTwoLabel1">
						<value form="">Switch entry to 1c:ZDV-3TC-EFV</value>
					</text>
					<text id="queTwoLabel2">
						<value form="">Keep Entry</value>
					</text>
					<text id="question3">
						<value form="long">ASK: Our records indicate you have been on treatment for 12 months. Is that correct?</value>
						<value form="short">Treatment Status</value>
					</text>
					<text id="question3hint">
						<value form="">Answer yes if the above is correct.</value>
					</text>
					<text id="queThreeLabel1">
						<value form="">YES</value>
					</text>
					<text id="queThreeLabel2">
						<value form="">NO</value>
					</text>
					<text id="question4">
						<value form="long">Remember to order the patients 12 months CD4 test!</value>
						<value form="short">Lab Test Order</value>
					</text>
					<text id="question4hint">
						<value form="">Press button</value>
					</text>
					<text id="question5_1">
						<value form="long">Enter Weight</value>
						<value form="short">Weight</value>
					</text>
					<text id="question5_1hint">
						<value form="">Enter Weight</value>
					</text>
					<text id="question5_2">
						<value form="long">Units</value>
						<value form="short">Units</value>
					</text>
					<text id="question5_2hint">
						<value form="">Select Units</value>
					</text>
					<text id="queFiveLabel1">
						<value form="">Kilograms</value>
					</text>
					<text id="queFiveLabel2">
						<value form="">Pounds</value>
					</text>
					<text id="question6">
						<value form="long">Weight Chart</value>
						<value form="short">Weight Chart</value>
					</text>
					<text id="question6hint">
						<value form="">Weight Chart</value>
					</text>
					<text id="question7">
						<value form="long">TB Status</value>
						<value form="short">TB Status</value>
					</text>
					<text id="question7hint">
						<value form="">Select TB Status</value>
					</text>
					<text id="queSevenLabel1">
						<value form="">NO TB treatment or signs</value>
					</text>
					<text id="queSevenLabel2">
						<value form="">Waiting for TB results</value>
					</text>
					<text id="queSevenLabel3">
						<value form="">On INH Prophylaxis</value>
					</text>
					<text id="queSevenLabel4">
						<value form="">TB confirmed, will start treatment</value>
					</text>
					<text id="question8">
						<value form="long">Now I will ask you some questions to determine if you need to see a doctor on this visit.</value>
						<value form="short">Questions</value>
					</text>
					<text id="question8hint">
						<value form="">Answer Correctly</value>
					</text>
					<text id="question9">
						<value form="long">Have You been admitted to hospital since your last visit?</value>
						<value form="short">Admission Status</value>
					</text>
					<text id="question9hint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="queNineLabel1">
						<value form="">NO</value>
					</text>
					<text id="queNineLabel2">
						<value form="">YES</value>
					</text>
					<text id="question10">
						<value form="long">Do you have any rash?</value>
						<value form="short">Rash</value>
					</text>
					<text id="question10hint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="queTenLabel1">
						<value form="">NO</value>
					</text>
					<text id="queTenLabel2">
						<value form="">YES</value>
					</text>
					<text id="question11">
						<value form="long">Is it new or getting worse since your last visit?</value>
						<value form="short">Status after last visit</value>
					</text>
					<text id="question11hint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="queElevenLabel1">
						<value form="">NO</value>
					</text>
					<text id="queElevenLabel2">
						<value form="">YES</value>
					</text>

					<text id="health">
						<value form="long">How have you been since the last visit?</value>
						<value form="short">Health since last visit</value>
					</text>
					<text id="healthHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="queHealthLabel1">
						<value form="">Better or no different</value>
					</text>
					<text id="queHealthLabel2">
						<value form="">Not well</value>
					</text>

					<text id="traditionalMedsText">
						<value form="long">Have you used any traditional medicines since your last visit?</value>
						<value form="short">Used Traditional Medicines</value>
					</text>
					<text id="traditionalMedsHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="traditionalMedsLabel1">
						<value form="">No</value>
					</text>
					<text id="traditionalMedsLabel2">
						<value form="">Yes</value>
					</text>

					<text id="newMedsText">
						<value form="long">Have you used any other new medications since your last visit?</value>
						<value form="short">Used New Medicines</value>
					</text>
					<text id="newMedsHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="newMedsLabel1">
						<value form="">No</value>
					</text>
					<text id="newMedsLabel2">
						<value form="">Yes</value>
					</text>

					<text id="lossLocationText">
						<value form="long">Have you lost weight on your face, arms, legs, or buttocks?</value>
						<value form="short">Lost Weight Locations</value>
					</text>
					<text id="lossLocationHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="lossLocationLabel1">
						<value form="">No</value>
					</text>
					<text id="lossLocationLabel2">
						<value form="">Yes</value>
					</text>

					<text id="botheredByLossText">
						<value form="long">Does this weight loss bother you?</value>
						<value form="short">Bothered By Loss</value>
					</text>
					<text id="botheredByLossHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="botheredByLossLabel1">
						<value form="">No</value>
					</text>
					<text id="botheredByLossLabel2">
						<value form="">Yes</value>
					</text>

					<text id="gainLocationText">
						<value form="long">Have you gained weight on your abdomen, breasts, or back of your neck?</value>
						<value form="short">Gained Weight Locations</value>
					</text>
					<text id="gainLocationHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="gainLocationLabel1">
						<value form="">No</value>
					</text>
					<text id="gainLocationLabel2">
						<value form="">Yes</value>
					</text>

					<text id="gainProportionalText">
						<value form="long">Are you gaining more weight there than in other parts of your body?</value>
						<value form="short">Gaining Weight Disproportionally</value>
					</text>
					<text id="gainProportionalHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="gainProportionalLabel1">
						<value form="">No</value>
					</text>
					<text id="gainProportionalLabel2">
						<value form="">Yes</value>
					</text>

					<text id="botheredByGainText">
						<value form="long">Does this weight gain bother you?</value>
						<value form="short">Bothered By Gain</value>
					</text>
					<text id="botheredByGainHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="botheredByGainLabel1">
						<value form="">No</value>
					</text>
					<text id="botheredByGainLabel2">
						<value form="">Yes</value>
					</text>

					<text id="onTbTreatmentText">
						<value form="long">Are you on TB treatment?</value>
						<value form="short">On TB Treatment</value>
					</text>
					<text id="onTbTreatmentHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="onTbTreatmentLabel1">
						<value form="">No</value>
					</text>
					<text id="onTbTreatmentLabel2">
						<value form="">Yes</value>
					</text>

					<text id="tbTreatmentFeelingBetterText">
						<value form="long">Are you feeling better on TB treatment?</value>
						<value form="short">Better on Treatment?</value>
					</text>
					<text id="tbTreatmentFeelingBetterHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="tbTreatmentFeelingBetterLabel1">
						<value form="">Feeling better</value>
					</text>
					<text id="tbTreatmentFeelingBetterLabel2">
						<value form="">Not feeling better</value>
					</text>

					<text id="coughingText">
						<value form="long">Are you coughing?</value>
						<value form="short">Coughing?</value>
					</text>
					<text id="coughingHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="coughingLabel1">
						<value form="">No</value>
					</text>
					<text id="coughingLabel2">
						<value form="">Yes</value>
					</text>

					<text id="housemateWithCoughTbText">
						<value form="long">Does anyone in your home have a cough or TB?</value>
						<value form="short">Housemate with Cough/TB</value>
					</text>
					<text id="housemateWithCoughTbHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="housemateWithCoughTbLabel1">
						<value form="">No</value>
					</text>
					<text id="housemateWithCoughTbLabel2">
						<value form="">Yes</value>
					</text>

					<text id="lengthCoughingText">
						<value form="long">How long have you been coughing?</value>
						<value form="short">Time Coughing</value>
					</text>
					<text id="lengthCoughingHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="lengthCoughingLabel1">
						<value form="">Less than 2 weeks</value>
					</text>
					<text id="lengthCoughingLabel2">
						<value form="">Longer than 2 weeks</value>
					</text>

					<text id="bloodySputumText">
						<value form="long">Do you have bloody sputum?</value>
						<value form="short">Bloody Sputum</value>
					</text>
					<text id="bloodySputumHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="bloodySputumLabel1">
						<value form="">No</value>
					</text>
					<text id="bloodySputumLabel2">
						<value form="">Yes</value>
					</text>

					<text id="nightSweatsText">
						<value form="long">Are you sweating at night?</value>
						<value form="short">Night Sweats</value>
					</text>
					<text id="nightSweatsHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="nightSweatsLabel1">
						<value form="">No</value>
					</text>
					<text id="nightSweatsLabel2">
						<value form="">Yes</value>
					</text>

					<text id="sweatSoaksText">
						<value form="long">Does the sweat soak your bedding and bed clothes?</value>
						<value form="short">Soaking Sweat</value>
					</text>
					<text id="sweatSoaksHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="sweatSoaksLabel1">
						<value form="">No</value>
					</text>
					<text id="sweatSoaksLabel2">
						<value form="">Yes</value>
					</text>

					<text id="nightlySoakText">
						<value form="long">Does it happen every night?</value>
						<value form="short">Soak Every Night</value>
					</text>
					<text id="nightlySoakHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="nightlySoakLabel1">
						<value form="">No</value>
					</text>
					<text id="nightlySoakLabel2">
						<value form="">Yes</value>
					</text>

					<text id="shortBreathText">
						<value form="long">Do you get short of breath when you walk around inside your house?</value>
						<value form="short">Short of Breath</value>
					</text>
					<text id="shortBreathHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="shortBreathLabel1">
						<value form="">No</value>
					</text>
					<text id="shortBreathLabel2">
						<value form="">Yes</value>
					</text>

					<text id="shortBreathStatusText">
						<value form="long">Is it new or getting worse since your last visit?</value>
						<value form="short">Worse Shortness</value>
					</text>
					<text id="shortBreathStatusHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="shortBreathStatusLabel1">
						<value form="">No</value>
					</text>
					<text id="shortBreathStatusLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="mouthPainText">
						<value form="long">Do you have pain or sores in your mouth or trouble swallowing?</value>
						<value form="short">Mouth Pain</value>
					</text>
					<text id="mouthPainHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="mouthPainLabel1">
						<value form="">No</value>
					</text>
					<text id="mouthPainLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="stomachPainText">
						<value form="long">Do you have stomach pain or discomfort?</value>
						<value form="short">Stomach Pain</value>
					</text>
					<text id="stomachPainHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="stomachPainLabel1">
						<value form="">No</value>
					</text>
					<text id="stomachPainLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="stomachWorseText">
						<value form="long">Is it new or getting worse since your last visit? </value>
						<value form="short">Worse Stomach Pain</value>
					</text>
					<text id="stomachWorseHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="stomachWorseLabel1">
						<value form="">No</value>
					</text>
					<text id="stomachWorseLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="diarrheaText">
						<value form="long">Do you have any diarrhea?</value>
						<value form="short">Diarrhea</value>
					</text>
					<text id="diarrheaHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="diarrheaLabel1">
						<value form="">No</value>
					</text>
					<text id="diarrheaLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="diarrheaWorseText">
						<value form="long">Is it new or getting worse since your last visit?</value>
						<value form="short">Worse Diarrhea</value>
					</text>
					<text id="diarrheaWorseHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="diarrheaWorseLabel1">
						<value form="">No</value>
					</text>
					<text id="diarrheaWorseLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="genitalProblemsText">
						<value form="long">Do you have any genital discharge, sores or problems? </value>
						<value form="short">Genital Pain</value>
					</text>
					<text id="genitalProblemsHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="genitalProblemsLabel1">
						<value form="">No</value>
					</text>
					<text id="genitalProblemsLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="vomitingText">
						<value form="long">Have you been vomiting?</value>
						<value form="short">Vomiting</value>
					</text>
					<text id="vomitingHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="vomitingLabel1">
						<value form="">No</value>
					</text>
					<text id="vomitingLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="headachesText">
						<value form="long">Have you been having headaches</value>
						<value form="short">Headaches</value>
					</text>
					<text id="headachesHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="headachesLabel1">
						<value form="">No</value>
					</text>
					<text id="headachesLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="headachesWorseText">
						<value form="long">Are these headaches new or getting worse since your last visit?</value>
						<value form="short">Worse Headaches</value>
					</text>
					<text id="headachesWorseHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="headachesWorseLabel1">
						<value form="">No</value>
					</text>
					<text id="headachesWorseLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="withVomitingText">
						<value form="long">Are the headaches associated with vomiting?</value>
						<value form="short">Headaches with Vomiting</value>
					</text>
					<text id="withVomitingHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="withVomitingLabel1">
						<value form="">No</value>
					</text>
					<text id="withVomitingLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="mentalStatusText">
						<value form="long">Are the associated headaches with mental status changes?</value>
						<value form="short">Mental Changes</value>
					</text>
					<text id="mentalStatusHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="mentalStatusLabel1">
						<value form="">No</value>
					</text>
					<text id="mentalStatusLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="withStiffNeckText">
						<value form="long">Are the headaches associated with a stiff neck?</value>
						<value form="short">Stiff Neck</value>
					</text>
					<text id="withStiffNeckHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="withStiffNeckLabel1">
						<value form="">No</value>
					</text>
					<text id="withStiffNeckLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="withMotorWeaknessText">
						<value form="long">Are the headaches associated with focal motor weakness?</value>
						<value form="short">Associated with Motor Problems</value>
					</text>
					<text id="withMotorWeaknessHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="withMotorWeaknessLabel1">
						<value form="">No</value>
					</text>
					<text id="withMotorWeaknessLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="listOfProblemsText">
						<value form="long">Does the patient have any of the following which have occurred since the last visit?</value>
						<value form="short">Patient Has</value>
					</text>
					<text id="listOfProblemsHint">
						<value form="">Select all that apply</value>
					</text>
					<text id="listOfProblemsLabel1">
						<value form="">Inability to walk</value>
					</text>
					<text id="listOfProblemsLabel2">
						<value form="">Inability to talk</value>
					</text>
					<text id="listOfProblemsLabel3">
						<value form="">Weakness on one side of the body</value>
					</text>
					<text id="listOfProblemsLabel4">
						<value form="">Weakness on one side of the face</value>
					</text>
								
					<text id="jaundiceText">
						<value form="long">Is the patient jaundiced?</value>
						<value form="short">Jaundice</value>
					</text>
					<text id="jaundiceHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="jaundiceLabel1">
						<value form="">No</value>
					</text>
					<text id="jaundiceLabel2">
						<value form="">Yes</value>
					</text>					
					
					<text id="burningHandsText">
						<value form="long">Do you have pain, burning, tingling or numbness in your feet or hands?</value>
						<value form="short">Burning in Extremities</value>
					</text>
					<text id="burningHandsHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="burningHandsLabel1">
						<value form="">No</value>
					</text>
					<text id="burningHandsLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="burningWorseText">
						<value form="long">Is it new or getting worse since your last visit? </value>
						<value form="short">Burning Worse</value>
					</text>
					<text id="burningWorseHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="burningWorseLabel1">
						<value form="">No</value>
					</text>
					<text id="burningWorseLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="rashText">
						<value form="long">Does the patient have any rash, such as sores, itchy lesions, bumps, or color changes in your skin?</value>
						<value form="short">Rash</value>
					</text>
					<text id="rashHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="rashLabel1">
						<value form="">No</value>
					</text>
					<text id="rashLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="dosesMissedText">
						<value form="long">How many times did you miss a dose in the past week?</value>
						<value form="short">Missed Doses</value>
					</text>
					<text id="dosesMissedHint">
						<value form="">Enter the number of doses missed by the patient in the previous week</value>
					</text>
					
					<text id="difficultyWeekendText">
						<value form="long">Do you have difficulty taking ARV meds on the weekends?</value>
						<value form="short">Problem with Weekends</value>
					</text>
					<text id="difficultyWeekendHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="difficultyWeekendLabel1">
						<value form="">No</value>
					</text>
					<text id="difficultyWeekendLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="otherProblemsText">
						<value form="long">Have you had any serious medical problems that I didn't ask about since the last visit?</value>
						<value form="short">New Problems</value>
					</text>
					<text id="otherProblemsHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="otherProblemsLabel1">
						<value form="">No</value>
					</text>
					<text id="otherProblemsLabel2">
						<value form="">Yes</value>
					</text>
					
					<text id="needToDiscussText">
						<value form="long">Do you have other problems that I didn't ask about that you need to discuss with the doctor?</value>
						<value form="short">Other Problems</value>
					</text>
					<text id="needToDiscussHint">
						<value form="">Select Correct answer</value>
					</text>
					<text id="needToDiscussLabel1">
						<value form="">No</value>
					</text>
					<text id="needToDiscussLabel2">
						<value form="">Yes</value>
					</text>
				</translation>
			</itext>
			<instance>
				<data>
					<ARVRegimen>
						<RegimenName />
						<RegimenChanged />
					</ARVRegimen>
					<Patient>
						<MonthsOnTreatment />
						<OnTreatment />
					</Patient>
					<Reminder>
						<ToOrder />
					</Reminder>
					<History>
						<data>5</data>
						<data>10</data>
						<data>20</data>
						<data>25</data>
						<data>35</data>
						<data>45</data>
						<data>58</data>
						<data>69</data>
						<data>80</data>
						<data>99</data>
					</History>
					<Disease>
						<Status />
					</Disease>
					<Ask>
						<Message />
					</Ask>
					<Rash>
						<Status />
						<IsImproved />
					</Rash>
					<General>
						<Health />
						<HospitalizedAdmission />
						<TraditionalMeds />
						<NewMeds />
					</General>
					<Weight>
						<LatestValue />
						<Units />
						<AmountLost />
						<LossLocation />
						<BotheredByLoss />
						<GainLocation />
						<GainProportional />
						<BotheredByGain />
					</Weight>
					<TbAndCoughing>
						<OnTbTreatment />
						<TbTreatmentFeelingBetter />
						<Cough>
							<Coughing />
							<HousemateWithCoughTb />
							<LengthCoughing />
							<BloodySputum />
						</Cough>
						<Sweats>
							<NightSweats />
							<SweatSoaks />
							<NightlySoak />
						</Sweats>
						<ShortBreath />
						<ShortBreathStatus />
					</TbAndCoughing>
					<GeneralOIs>
						<MouthPain/>
						<StomachPain/>
						<StomachWorse/>
						<Diarrhea/>
						<DiarrheaWorse/>
						<GenitalProblems/>
						<Vomiting/>
					</GeneralOIs>
					<HeadProblems>
						<Headaches/>
						<HeadachesWorse/>
						<WithVomiting/>
						<MentalStatus/>
						<WithStiffNeck/>
						<WithMotorWeakness/>
						<ListOfProblems/>
					</HeadProblems>
					<ARVToxicity>
						<Jaundice/>
						<BurningHands/>
						<BurningWorse/>
						<Rash/>
					</ARVToxicity>
					<Adherence>
						<DosesMissed/>
						<DifficultyWeekend/>						
					</Adherence>
					<Other>
						<OtherProblems/>
						<NeedToDiscuss/>
					</Other>
				</data>
			</instance>
			<bind id="regimenName" nodeset="/data/ARVRegimen/RegimenName" type="xsd:string" />
			<bind id="regimenChanged" nodeset="/data/ARVRegimen/RegimenChanged" type="xsd:string" />

			<bind id="monthsOnTreatment" nodeset="/data/Patient/MonthsOnTreatment" type="xsd:integer" jr:preload="patient" jr:preloadParams="monthsOnTreatment" />
			<bind id="onTreatment" nodeset="/data/Patient/OnTreatment" type="xsd:string" />

			<bind id="toOrder" nodeset="/data/Reminder/ToOrder" type="xsd:string" />

			<bind id="history" nodeset="/data/History/data" type="jr:numtable" jr:preload="patient" jr:preloadParams="weight[:10:N]"/>

			<bind id="status" nodeset="/data/Disease/Status" type="xsd:string" />

			<bind id="message" nodeset="/data/Ask/Message" type="xsd:string" />

			<bind id="rashStatus" nodeset="/data/Rash/Status" type="xsd:string" />
			<bind id="isImproved" nodeset="/data/Rash/IsImproved" type="xsd:string" />

			<bind id="health" nodeset="/data/General/Health" type="xsd:string" />
			<bind id="admissionStatus" nodeset="/data/General/HospitalAdmission" type="xsd:string" />
			<bind id="traditionalMeds" nodeset="/data/General/traditionalMeds" type="xsd:string" />
			<bind id="newMeds" nodeset="/data/General/NewMeds" type="xsd:string" />

			<bind id="weightValue" nodeset="/data/Weight/LatestValue" type="xsd:integer" />
			<bind id="units" nodeset="/data/Weight/Units" type="xsd:string" />
			<bind id="lossLocation" nodeset="/data/Weight/LossLocation" type="xsd:string" />
			<bind id="botheredByLoss" nodeset="/data/Weight/BotheredByLoss" type="xsd:string" />
			<bind id="gainLocation" nodeset="/data/Weight/GainLocation" type="xsd:string" />
			<bind id="gainProportional" nodeset="/data/Weight/GainProportional" type="xsd:string" />
			<bind id="botheredByGain" nodeset="/data/Weight/BotheredByGain" type="xsd:string" />

			<bind id="onTbTreatment" nodeset="/data/TbAndCoughing/OnTbTreatment" type="xsd:string" />
			<bind id="tbTreatmentFeelingBetter" nodeset="/data/TbAndCoughing/TbTreatmentFeelingBetter" type="xsd:string" />
			<bind id="coughing" nodeset="/data/TbAndCoughing/Cough/Coughing" type="xsd:string" />
			<bind id="housemateWithCoughTb" nodeset="/data/TbAndCoughing/Cough/HousemateWithCoughTb" type="xsd:string" />
			<bind id="lengthCoughing" nodeset="/data/TbAndCoughing/Cough/LengthCoughing" type="xsd:string" />
			<bind id="bloodySputum" nodeset="/data/TbAndCoughing/Cough/BloodySputum" type="xsd:string" />
			<bind id="nightSweats" nodeset="/data/TbAndCoughing/Sweats/NightSweats" type="xsd:string" />
			<bind id="sweatSoaks" nodeset="/data/TbAndCoughing/Sweats/SweatSoaks" type="xsd:string" />
			<bind id="nightlySoak" nodeset="/data/TbAndCoughing/Sweats/NightlySoak" type="xsd:string" />
			<bind id="shortBreath" nodeset="/data/TbAndCoughing/ShortBreath" type="xsd:string" />
			<bind id="shortBreathStatus" nodeset="/data/TbAndCoughing/ShortBreathStatus" type="xsd:string" />

			<bind id="mouthPain" nodeset="/data/GeneralOis/MouthPain" type="xsd:string" />
			<bind id="stomachPain" nodeset="/data/GeneralOis/StomachPain" type="xsd:string" />
			<bind id="stomachWorse" nodeset="/data/GeneralOis/StomachWorse" type="xsd:string" />
			<bind id="diarrhea" nodeset="/data/GeneralOis/Diarrhea" type="xsd:string" />
			<bind id="diarrheaWorse" nodeset="/data/GeneralOis/DiarrheaWorse" type="xsd:string" />
			<bind id="genitalProblems" nodeset="/data/GeneralOis/GenitalProblems" type="xsd:string" />
			<bind id="vomiting" nodeset="/data/GeneralOis/Vomiting" type="xsd:string" />
			
			<bind id="headaches" nodeset="/data/HeadProblems/Headaches" type="xsd:string" />
			<bind id="headachesWorse" nodeset="/data/HeadProblems/HeadachesWorse" type="xsd:string" />
			<bind id="withVomiting" nodeset="/data/HeadProblems/WithVomiting" type="xsd:string" />
			<bind id="mentalStatus" nodeset="/data/HeadProblems/MentalStatus" type="xsd:string" />
			<bind id="withStiffNeck" nodeset="/data/HeadProblems/WithStiffNeck" type="xsd:string" />
			<bind id="withMotorWeakness" nodeset="/data/HeadProblems/WithMotorWeakness" type="xsd:string" />
			<bind id="listOfProblems" nodeset="/data/HeadProblems/ListOfProblems" type="xsd:string" />
			
			<bind id="jaundice" nodeset="/data/ARVToxicity/Jaundice" type="xsd:string" />
			<bind id="burningHands" nodeset="/data/ARVToxicity/BurningHands" type="xsd:string" />
			<bind id="burningWorse" nodeset="/data/ARVToxicity/BurningWorse" type="xsd:string" />
			<bind id="rash" nodeset="/data/ARVToxicity/Rash" type="xsd:string" />
			
			<bind id="dosesMissed" nodeset="/data/Adherence/DosesMissed" type="xsd:integer" />
			<bind id="difficultyWeekend" nodeset="/data/Adherence/DifficultyWeekend" type="xsd:string" />
			
			<bind id="otherProblems" nodeset="/data/Other/OtherProblems" type="xsd:string" />
			<bind id="needToDiscuss" nodeset="/data/Other/NeedToDiscuss" type="xsd:string" />
			
		</model>
	</h:head>
	<h:body>
		<select1 bind="regimenName" appearance="full">
			<label ref="jr:itext('question1')"/>
			<hint ref="jr:itext('question1hint')"/>
			<item>
				<label ref="jr:itext('queOneLabel1')"/>
				<value>1a30:d4T30-3TC-NVP</value>
			</item>
			<item>
				<label ref="jr:itext('queOneLabel2')"/>
				<value>1a40:d4T30-3TC-NVP</value>
			</item>
			<item>
				<label ref="jr:itext('queOneLabel3')"/>
				<value>1a30-S: starting</value>
			</item>
			<item>
				<label ref="jr:itext('queOneLabel4')"/>
				<value>1a40-S: starting</value>
			</item>
			<item>
				<label ref="jr:itext('queOneLabel5')"/>
				<value>1b:ZDV-CTC-NVP</value>
			</item>
			<item>
				<label ref="jr:itext('queOneLabel6')"/>
				<value>1c:ZDV-3TC-EFV</value>
			</item>
			<item>
				<label ref="jr:itext('queOneLabel7')"/>
				<value>1d40:d4T40-3TC-EFV</value>
			</item>
			<item>
				<label ref="jr:itext('queOneLabel8')"/>
				<value>2b:ABC-ddl-SQV/r</value>
			</item>
			<item>
				<label ref="jr:itext('queOneLabel9')"/>
				<value>2a:ABC-ddl-LPV/r</value>
			</item>
			<item>
				<label ref="jr:itext('queOneLabel10')"/>
				<value>2c:ABC-ddl-NFV</value>
			</item>
			<item>
				<label ref="jr:itext('queOneLabel11')"/>
				<value>Other regimen</value>
			</item>
			<item>
				<label ref="jr:itext('queOneLabel12')"/>
				<value>Not on Arvs Yet</value>
			</item>
		</select1 >
		<select1 relevant="/HMISFormA/internal/more1!='1c:ZDV-3TC-EFV'" bind="regimenChanged" appearance="full">
			<label ref="jr:itext('question2')"/>
			<hint ref="jr:itext('question2hint')"/>
			<item>
				<label ref="jr:itext('queTwoLabel1')"/>
				<value>1c:ZDV-3TC-EFV</value>
			</item>
			<item>
				<label ref="jr:itext('queTwoLabel2')"/>
				<value>Keep my current Entry</value>
			</item>
		</select1 >
		<select1 relevant="/data/Patient/MonthsOnTreatment>=12" bind="onTreatment" appearance="full">
			<label ref="jr:itext('question3')"/>
			<hint ref="jr:itext('question3hint')"/>
			<item>
				<label ref="jr:itext('queThreeLabel1')"/>
				<value>Yes</value>
			</item>
			<item>
				<label ref="jr:itext('queThreeLabel2')"/>
				<value>No</value>
			</item>
		</select1 >
		<trigger bind="toOrder">
			<label ref="jr:itext('question4')"/>
			<hint ref="jr:itext('question4hint')"/>
		</trigger >
		<input bind="weightValue">
			<label ref="jr:itext('question5_1')"/>
			<hint ref="jr:itext('question5_1hint')"/>
		</input >
		<select1 bind="units" appearance="full">
			<label ref="jr:itext('question5_2')"/>
			<hint ref="jr:itext('question5_2hint')"/>
			<item>
				<label ref="jr:itext('queFiveLabel1')"/>
				<value>Kilograms</value>
			</item>
			<item>
				<label ref="jr:itext('queFiveLabel2')"/>
				<value>Pounds</value>
			</item>
		</select1 >
		<output bind="history" type="graph">
			<label ref="jr:itext('question6')"/>
			<hint ref="jr:itext('question6hint')"/>
		</output >
		<select bind="status" appearance="full">
			<label ref="jr:itext('question7')"/>
			<hint ref="jr:itext('question7hint')"/>
			<item>
				<label ref="jr:itext('queSevenLabel1')"/>
				<value>NO TB treatment or signs</value>
			</item>
			<item>
				<label ref="jr:itext('queSevenLabel2')"/>
				<value>Waiting for TB results</value>
			</item>
			<item>
				<label ref="jr:itext('queSevenLabel3')"/>
				<value>On INH Prophylaxis</value>
			</item>
			<item>
				<label ref="jr:itext('queSevenLabel4')"/>
				<value>TB confirmed, will start treatment</value>
			</item>
		</select >
		<trigger bind="message">
			<label ref="jr:itext('question8')"/>
			<hint ref="jr:itext('question8hint')"/>
		</trigger >
		<select1 bind="rashStatus" appearance="full">
			<label ref="jr:itext('question10')"/>
			<hint ref="jr:itext('question10hint')"/>
			<item>
				<label ref="jr:itext('queTenLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('queTenLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >
		<select1 relevant="/data/Rash/Status='Yes'" bind="isImproved" appearance="full">
			<label ref="jr:itext('question11')"/>
			<hint ref="jr:itext('question11hint')"/>
			<item>
				<label ref="jr:itext('queElevenLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('queElevenLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >

		<select1 bind="health" appearance="full">
			<label ref="jr:itext('health')"/>
			<hint ref="jr:itext('healthHint')"/>
			<item>
				<label ref="jr:itext('queHealthLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('queHealthLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >

		<select1 bind="admissionStatus" appearance="full">
			<label ref="jr:itext('question9')"/>
			<hint ref="jr:itext('question9hint')"/>
			<item>
				<label ref="jr:itext('queNineLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('queNineLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >

		<select1 bind="traditionalMeds" appearance="full">
			<label ref="jr:itext('traditionalMedsText')"/>
			<hint ref="jr:itext('traditionalMedsHint')"/>
			<item>
				<label ref="jr:itext('traditionalMedsLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('traditionalMedsLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >

		<select1 bind="newMeds" appearance="full">
			<label ref="jr:itext('newMedsText')"/>
			<hint ref="jr:itext('newMedsHint')"/>
			<item>
				<label ref="jr:itext('newMedsLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('newMedsLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >

		<select1 bind="lossLocation" appearance="full">
			<label ref="jr:itext('lossLocationText')"/>
			<hint ref="jr:itext('lossLocationHint')"/>
			<item>
				<label ref="jr:itext('lossLocationLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('lossLocationLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >
		<select1 relevant="/data/Weight/LossLocation='Yes'" bind="botheredByLoss" appearance="full">
			<label ref="jr:itext('botheredByLossText')"/>
			<hint ref="jr:itext('botheredByLossHint')"/>
			<item>
				<label ref="jr:itext('botheredByLossLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('botheredByLossLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >

		<select1 bind="gainLocation" appearance="full">
			<label ref="jr:itext('gainLocationText')"/>
			<hint ref="jr:itext('gainLocationHint')"/>
			<item>
				<label ref="jr:itext('gainLocationLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('gainLocationLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >

		<select1 relevant="/data/Weight/GainLocation='Yes'" bind="gainProportional" appearance="full">
			<label ref="jr:itext('gainProportionalText')"/>
			<hint ref="jr:itext('gainProportionalHint')"/>
			<item>
				<label ref="jr:itext('gainProportionalLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('gainProportionalLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >
		<select1 relevant="/data/Weight/GainProportional='Yes'" bind="botheredByGain" appearance="full">
			<label ref="jr:itext('botheredByGainText')"/>
			<hint ref="jr:itext('botheredByGainHint')"/>
			<item>
				<label ref="jr:itext('botheredByGainLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('botheredByGainLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >

		<select1 bind="onTbTreatment" appearance="full">
			<label ref="jr:itext('onTbTreatmentText')"/>
			<hint ref="jr:itext('onTbTreatmentHint')"/>
			<item>
				<label ref="jr:itext('onTbTreatmentLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('onTbTreatmentLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >

		<select1 relevant="/data/TbAndCoughing/OnTbTreatment='Yes'" bind="tbTreatmentFeelingBetter" appearance="full">
			<label ref="jr:itext('tbTreatmentFeelingBetterText')"/>
			<hint ref="jr:itext('tbTreatmentFeelingBetterHint')"/>
			<item>
				<label ref="jr:itext('tbTreatmentFeelingBetterLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('tbTreatmentFeelingBetterLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >

		<select1 relevant="/data/TbAndCoughing/OnTbTreatment='NO'" bind="coughing" appearance="full">
			<label ref="jr:itext('coughingText')"/>
			<hint ref="jr:itext('coughingHint')"/>
			<item>
				<label ref="jr:itext('coughingLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('coughingLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >

		<select1 relevant="/data/TbAndCoughing/Cough/Coughing='Yes'" bind="housemateWithCoughTb" appearance="full">
			<label ref="jr:itext('housemateWithCoughTbText')"/>
			<hint ref="jr:itext('housemateWithCoughTbHint')"/>
			<item>
				<label ref="jr:itext('housemateWithCoughTbLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('housemateWithCoughTbLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >

		<select1 relevant="/data/TbAndCoughing/Cough/Coughing='Yes'" bind="lengthCoughing" appearance="full">
			<label ref="jr:itext('lengthCoughingText')"/>
			<hint ref="jr:itext('lengthCoughingHint')"/>
			<item>
				<label ref="jr:itext('lengthCoughingLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('lengthCoughingLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >

		<select1 relevant="/data/TbAndCoughing/Cough/Coughing='Yes'" bind="bloodySputum" appearance="full">
			<label ref="jr:itext('bloodySputumText')"/>
			<hint ref="jr:itext('bloodySputumHint')"/>
			<item>
				<label ref="jr:itext('bloodySputumLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('bloodySputumLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >

		<select1 bind="nightSweats" appearance="full">
			<label ref="jr:itext('nightSweatsText')"/>
			<hint ref="jr:itext('nightSweatsHint')"/>
			<item>
				<label ref="jr:itext('nightSweatsLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('nightSweatsLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >

		<select1 relevant="/data/TbAndCoughing/Sweats/SweatSoaks='Yes'" bind="sweatSoaks" appearance="full">
			<label ref="jr:itext('sweatSoaksText')"/>
			<hint ref="jr:itext('sweatSoaksHint')"/>
			<item>
				<label ref="jr:itext('sweatSoaksLabel1')"/>
				<value>NO</value>
			</item>
			<item>
				<label ref="jr:itext('sweatSoaksLabel2')"/>
				<value>Yes</value>
			</item>
		</select1 >

		<select1 relevant="/data/TbAndCoughing/Sweats/NightlySoak='Yes'" bind="nightlySoak" appearance="full">
			<label ref="jr:itext('nightlySoakText')"/>
			<hint ref="jr:itext('nightlySoakHint')"/>
			<item>
				<label ref ="jr:itext('nightlySoakLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('nightlySoakLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >

		<select1 bind="shortBreath" appearance="full" >
			<label ref ="jr:itext('shortBreathText')" />
			<hint ref ="jr:itext('shortBreathHint')" />
			<item>
				<label ref ="jr:itext('shortBreathLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('shortBreathLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >

		<select1 relevant="/data/TbAndCoughing/ShortBreath='Yes'" bind="shortBreathStatus" appearance="full" >
			<label ref ="jr:itext('shortBreathStatusText')" />
			<hint ref ="jr:itext('shortBreathStatusHint')" />
			<item>
				<label ref ="jr:itext('shortBreathStatusLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('shortBreathStatusLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<select1 bind="mouthPain" appearance="full" >
			<label ref ="jr:itext('mouthPainText')" />
			<hint ref ="jr:itext('mouthPainHint')" />
			<item>
				<label ref ="jr:itext('mouthPainLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('mouthPainLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<select1 bind="stomachPain" appearance="full" >
			<label ref ="jr:itext('stomachPainText')" />
			<hint ref ="jr:itext('stomachPainHint')" />
			<item>
				<label ref ="jr:itext('stomachPainLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('stomachPainLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<select1 relevant="/data/GeneralOIs/StomachPain='Yes'" bind="stomachWorse" appearance="full" >
			<label ref ="jr:itext('stomachWorseText')" />
			<hint ref ="jr:itext('stomachWorseHint')" />
			<item>
				<label ref ="jr:itext('stomachWorseLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('stomachWorseLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<select1 bind="diarrhea" appearance="full" >
			<label ref ="jr:itext('diarrheaText')" />
			<hint ref ="jr:itext('diarrheaHint')" />
			<item>
				<label ref ="jr:itext('diarrheaLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('diarrheaLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<select1 relevant="/data/GeneralOIs/Diarrhea='Yes'" bind="diarrheaWorse" appearance="full" >
			<label ref ="jr:itext('diarrheaWorseText')" />
			<hint ref ="jr:itext('diarrheaWorseHint')" />
			<item>
				<label ref ="jr:itext('diarrheaWorseLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('diarrheaWorseLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<select1 bind="genitalProblems" appearance="full" >
			<label ref ="jr:itext('genitalProblemsText')" />
			<hint ref ="jr:itext('genitalProblemsHint')" />
			<item>
				<label ref ="jr:itext('genitalProblemsLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('genitalProblemsLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<select1 bind="vomiting" appearance="full" >
			<label ref ="jr:itext('vomitingText')" />
			<hint ref ="jr:itext('vomitingHint')" />
			<item>
				<label ref ="jr:itext('vomitingLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('vomitingLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<select1 bind="headaches" appearance="full" >
			<label ref ="jr:itext('headachesText')" />
			<hint ref ="jr:itext('headachesHint')" />
			<item>
				<label ref ="jr:itext('headachesLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('headachesLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<select1 relevant="/data/HeadProblems/Headaches='Yes'" bind="headachesWorse" appearance="full" >
			<label ref ="jr:itext('headachesWorseText')" />
			<hint ref ="jr:itext('headachesWorseHint')" />
			<item>
				<label ref ="jr:itext('headachesWorseLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('headachesWorseLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<select1 relevant="/data/HeadProblems/Headaches='Yes'" bind="withVomiting" appearance="full" >
			<label ref ="jr:itext('withVomitingText')" />
			<hint ref ="jr:itext('withVomitingHint')" />
			<item>
				<label ref ="jr:itext('withVomitingLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('withVomitingLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<select1 relevant="/data/HeadProblems/Headaches='Yes'" bind="mentalStatus" appearance="full" >
			<label ref ="jr:itext('mentalStatusText')" />
			<hint ref ="jr:itext('mentalStatusHint')" />
			<item>
				<label ref ="jr:itext('mentalStatusLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('mentalStatusLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<select1 relevant="/data/HeadProblems/Headaches='Yes'" bind="withStiffNeck" appearance="full" >
			<label ref ="jr:itext('withStiffNeckText')" />
			<hint ref ="jr:itext('withStiffNeckHint')" />
			<item>
				<label ref ="jr:itext('withStiffNeckLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('withStiffNeckLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<select1 relevant="/data/HeadProblems/Headaches='Yes'" bind="withMotorWeakness" appearance="full" >
			<label ref ="jr:itext('withMotorWeaknessText')" />
			<hint ref ="jr:itext('withMotorWeaknessHint')" />
			<item>
				<label ref ="jr:itext('withMotorWeaknessLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('withMotorWeaknessLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<select bind="listOfProblems" appearance="full">
			<label ref="jr:itext('listOfProblemsText')"/>
			<hint ref="jr:itext('listOfProblemsHint')"/>
			<item>
				<label ref="jr:itext('listOfProblemsLabel1')"/>
				<value>Inability to walk</value>
			</item>
			<item>
				<label ref="jr:itext('listOfProblemsLabel2')"/>
				<value>Inability to talk</value>
			</item>
			<item>
				<label ref="jr:itext('listOfProblemsLabel3')"/>
				<value>Weakness on one side of the body</value>
			</item>
			<item>
				<label ref="jr:itext('listOfProblemsLabel4')"/>
				<value>Weakness on one side of the face</value>
			</item>
		</select>
		
		<select1 bind="jaundice" appearance="full" >
			<label ref ="jr:itext('jaundiceText')" />
			<hint ref ="jr:itext('jaundiceHint')" />
			<item>
				<label ref ="jr:itext('jaundiceLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('jaundiceLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<select1 bind="burningHands" appearance="full" >
			<label ref ="jr:itext('burningHandsText')" />
			<hint ref ="jr:itext('burningHandsHint')" />
			<item>
				<label ref ="jr:itext('burningHandsLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('burningHandsLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<select1 relevant="/data/ARVToxicity/BurningHands='Yes'" bind="burningWorse" appearance="full" >
			<label ref ="jr:itext('burningWorseText')" />
			<hint ref ="jr:itext('burningWorseHint')" />
			<item>
				<label ref ="jr:itext('burningWorseLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('burningWorseLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<select1 bind="rash" appearance="full" >
			<label ref ="jr:itext('rashText')" />
			<hint ref ="jr:itext('rashHint')" />
			<item>
				<label ref ="jr:itext('rashLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('rashLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<input bind="dosesMissed">
			<label ref="jr:itext('dosesMissedText')"/>
			<hint ref="jr:itext('dosesMissedHint')"/>
		</input >
		
		<select1 bind="difficultyWeekend" appearance="full" >
			<label ref ="jr:itext('difficultyWeekendText')" />
			<hint ref ="jr:itext('difficultyWeekendHint')" />
			<item>
				<label ref ="jr:itext('difficultyWeekendLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('difficultyWeekendLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
		
		<select1 bind="otherProblems" appearance="full" >
			<label ref ="jr:itext('otherProblemsText')" />
			<hint ref ="jr:itext('otherProblemsHint')" />
			<item>
				<label ref ="jr:itext('otherProblemsLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('otherProblemsLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >
					
		<select1 bind="needToDiscuss" appearance="full" >
			<label ref ="jr:itext('needToDiscussText')" />
			<hint ref ="jr:itext('needToDiscussHint')" />
			<item>
				<label ref ="jr:itext('needToDiscussLabel1')" />
				<value>NO</value>
			</item>
			<item>
				<label ref ="jr:itext('needToDiscussLabel2')" />
				<value>Yes</value>
			</item>
		</select1 >			
	</h:body>
</h:html>
